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de Miranda LLR, Harvey KE, Ahmed A, Harvey SC. UV-filter pollution: current concerns and future prospects. Environ Monit Assess 2021; 193:840. [PMID: 34822005 DOI: 10.1007/s10661-021-09626-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/12/2021] [Indexed: 05/20/2023]
Abstract
UV-filters are widely used in cosmetics and personal care products to protect users' skin from redamage caused by ultraviolet (UV) radiation from the sun. Globally, an estimated 16,000 to 25,000 tonnes of products containing UV-filters were used in 2014 with modern consumption likely to be much higher. Beyond this use in cosmetics and personal care products, UV-filters are also widely used to provide UV-stability in industrial products such as paints and plastics. This review discusses the main routes by which UV-filters enter aquatic environments and summarises the conclusions of studies from the past 10 years that have investigated the effects of UV-filters on environmentally relevant species including corals, microalgae, fish, and marine mammals. Safety data regarding the potential impact of UV-filters on human health are also discussed. Finally, we explore the challenges surrounding UV-filter removal and research on more environmentally friendly alternatives to current UV-filters.
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Affiliation(s)
- L L R de Miranda
- Biomolecular Research Group, School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, CT1 1QU, UK
| | - K E Harvey
- Biomolecular Research Group, School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, CT1 1QU, UK
| | - A Ahmed
- Biomolecular Research Group, School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, CT1 1QU, UK
| | - S C Harvey
- Biomolecular Research Group, School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, CT1 1QU, UK.
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2
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Yi PH, Singh D, Harvey SC, Hager GD, Mullen LA. DeepCAT: Deep Computer-Aided Triage of Screening Mammography. J Digit Imaging 2021; 34:27-35. [PMID: 33432446 PMCID: PMC7887113 DOI: 10.1007/s10278-020-00407-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/30/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022] Open
Abstract
Although much deep learning research has focused on mammographic detection of breast cancer, relatively little attention has been paid to mammography triage for radiologist review. The purpose of this study was to develop and test DeepCAT, a deep learning system for mammography triage based on suspicion of cancer. Specifically, we evaluate DeepCAT's ability to provide two augmentations to radiologists: (1) discarding images unlikely to have cancer from radiologist review and (2) prioritization of images likely to contain cancer. We used 1878 2D-mammographic images (CC & MLO) from the Digital Database for Screening Mammography to develop DeepCAT, a deep learning triage system composed of 2 components: (1) mammogram classifier cascade and (2) mass detector, which are combined to generate an overall priority score. This priority score is used to order images for radiologist review. Of 595 testing images, DeepCAT recommended low priority for 315 images (53%), of which none contained a malignant mass. In evaluation of prioritizing images according to likelihood of containing cancer, DeepCAT's study ordering required an average of 26 adjacent swaps to obtain perfect review order. Our results suggest that DeepCAT could substantially increase efficiency for breast imagers and effectively triage review of mammograms with malignant masses.
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Affiliation(s)
- Paul H Yi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
| | - Dhananjay Singh
- Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | | | - Gregory D Hager
- Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Lisa A Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
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3
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Ong A, Azizi A, Ambinder EB, Oluyemi ET, Harvey SC, Hung J. Image-guided Procedure Versus 2-year Follow-up for a BI-RADS 3 Probably Benign Lesion: A Cost Comparison Analysis. J Breast Imaging 2021; 3:57-63. [PMID: 38424837 DOI: 10.1093/jbi/wbaa087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Perform a comparison between the costs of image-guided breast procedures versus 2-year imaging follow-up for findings classified as BI-RADS assessment category 3-probably benign. METHODS The national payment amount costs at non-facility locations were obtained from the Centers for Medicare and Medicaid Services physician fee schedule for breast imaging-related Current Procedural Terminology codes. Total costs were calculated and compared for management algorithms of 2-year imaging follow-up of a BI-RADS 3 lesion from 2018 through 2019 versus performing an image-guided procedure of the lesion in 2018 after the initial diagnostic imaging. RESULTS Two-year mammographic follow-up of a BI-RADS 3 finding costs $484. This was less than a stereotactic-guided breast biopsy, which cost at least $1055. Two-year follow-up for a probably benign US finding cost $615 compared to $1173 for the least expensive US-guided breast biopsy scenario. For breast MRI, 2-year imaging follow-up cost $1510, which was also less than most MRI-guided breast biopsy scenarios. The one exception in which biopsy costs less than 2-year imaging follow-up was in the setting of an MRI-guided biopsy in the average-risk population without a post-benign biopsy follow-up breast MRI; in this setting, MRI biopsy cost $1235. CONCLUSION In 2018-2019, 2-year imaging follow-up of a BI-RADS 3 finding continues to be less costly than an immediate procedure, except for MRI-guided breast biopsy in the average-risk population without a post-benign biopsy follow-up MRI.
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Affiliation(s)
- Andrew Ong
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Armina Azizi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Emily B Ambinder
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Eniola T Oluyemi
- Johns Hopkins Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD
| | - Susan C Harvey
- Hologic, Inc., Department of Breast and Skeletal Health, Danbury, CT
| | - Jessica Hung
- Christiana Care Health System, Department of Radiology, Newark, DE
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Amir T, Ambinder EB, Harvey SC, Oluyemi ET, Jones MK, Honig E, Alvin MD, Mullen LA. Benefits of digital breast tomosynthesis: A lesion-level analysis. J Med Screen 2020; 28:311-317. [PMID: 33334233 DOI: 10.1177/0969141320978267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare outcome metrics of digital breast tomosynthesis (DBT) breast cancer screening with full-field digital mammogram (FFDM); specifically, to compare recall rates by the type of recalled finding, and to assess if screening with DBT versus FFDM changes biopsy recommendations and if the likelihood of malignancy varied by lesion type, if detected on DBT or FFDM screening mammogram. METHODS The outcomes of 22,055 FFDM and DBT screening mammograms were retrospectively reviewed. The exams were performed at an academic institution between August 2015 and September 2016. Performance of screening with FFDM versus DBT was compared in terms of recall rate and percentage of recalled lesions resulting in a cancer diagnosis, with subset analyses performed for specific mammographic findings. RESULTS The recall rate was 10.6% for FFDM and 8.0% for DBT (p < 0.001). Architectural distortion was more likely to be recalled on DBT screening than FFDM (p = 0.002), and was associated with an increased likelihood of malignancy (p = 0.008). Asymmetries were less likely to be recalled on DBT than FFDM (p < 0.001) screening mammogram, but more likely to be recommended for biopsy when detected on DBT. Calcifications more frequently required short-term follow-up or biopsy on both DBT and FFDM. CONCLUSIONS DBT screening confers an advantage in detection of architectural distortion representing malignancy. Recall rate of asymmetries are reduced with screening DBT, probably due to reduction of tissue superimposition. Calcifications pose a particularly difficult diagnostic challenge for breast imagers, regardless of screening mammogram type.
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Affiliation(s)
- Tali Amir
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily B Ambinder
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Eniola T Oluyemi
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mary K Jones
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Evan Honig
- Weill Cornell Medical College, New York, NY
| | - Matthew D Alvin
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa A Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Yi PH, Lin A, Wei J, Yu AC, Sair HI, Hui FK, Hager GD, Harvey SC. Deep-Learning-Based Semantic Labeling for 2D Mammography and Comparison of Complexity for Machine Learning Tasks. J Digit Imaging 2020; 32:565-570. [PMID: 31197559 PMCID: PMC6646449 DOI: 10.1007/s10278-019-00244-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Machine learning has several potential uses in medical imaging for semantic labeling of images to improve radiologist workflow and to triage studies for review. The purpose of this study was to (1) develop deep convolutional neural networks (DCNNs) for automated classification of 2D mammography views, determination of breast laterality, and assessment and of breast tissue density; and (2) compare the performance of DCNNs on these tasks of varying complexity to each other. We obtained 3034 2D-mammographic images from the Digital Database for Screening Mammography, annotated with mammographic view, image laterality, and breast tissue density. These images were used to train a DCNN to classify images for these three tasks. The DCNN trained to classify mammographic view achieved receiver-operating-characteristic (ROC) area under the curve (AUC) of 1. The DCNN trained to classify breast image laterality initially misclassified right and left breasts (AUC 0.75); however, after discontinuing horizontal flips during data augmentation, AUC improved to 0.93 (p < 0.0001). Breast density classification proved more difficult, with the DCNN achieving 68% accuracy. Automated semantic labeling of 2D mammography is feasible using DCNNs and can be performed with small datasets. However, automated classification of differences in breast density is more difficult, likely requiring larger datasets.
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Affiliation(s)
- Paul H Yi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD, 21287, USA. .,Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA.
| | - Abigail Lin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD, 21287, USA
| | - Jinchi Wei
- Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Alice C Yu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD, 21287, USA
| | - Haris I Sair
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD, 21287, USA.,Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Ferdinand K Hui
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD, 21287, USA.,Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Gregory D Hager
- Radiology Artificial Intelligence Lab (RAIL), Malone Center for Engineering in Healthcare, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
| | - Susan C Harvey
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Room 4223, Baltimore, MD, 21287, USA
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Nguyen DL, Oluyemi E, Myers KS, Harvey SC, Mullen LA, Ambinder EB. Impact of Telephone Communication on Patient Adherence With Follow-Up Recommendations After an Abnormal Screening Mammogram. J Am Coll Radiol 2020; 17:1139-1148. [DOI: 10.1016/j.jacr.2020.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
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7
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Abstract
Breast cancer is emerging as a major global public health problem. Incidence and mortality continues to rise in low- and middle-income countries (LMICs). A significant and growing disparity exists between high-income countries and LMICs in the availability of screening services and associated preventable mortality. However, population imaging-based screening programs are not appropriate for all settings. Planners should perform a thorough assessment of the target setting prior to implementing any breast cancer detection program, as appropriate guidelines vary according to the resources available. Financial, social, and cultural barriers to breast cancer care need to be addressed to sustainably improve the morbidity and mortality of the populations and make efficient use of available services. Creative approaches, such as mobile and portable imaging and bundling of services, can facilitate the installation of early breast cancer detection programs in LMICs. While image-based screening programs are not initially resource-appropriate in many LMICs, planners can work towards this goal as part of their comprehensive breast cancer detection strategy.
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Affiliation(s)
- Erica B Pollack
- Denver Health and Hospital Authority, Department of Radiology, Denver, CO
- RAD-AID International, Chevy Chase, MD
| | | | - Alice Chong
- RAD-AID International, Chevy Chase, MD
- University of California San Diego, Department of Radiology, San Diego, CA
| | - Susan C Harvey
- RAD-AID International, Chevy Chase, MD
- Hologic Inc., Department of Breast and Skeletal Health, Danbury, CT
| | - John R Scheel
- RAD-AID International, Chevy Chase, MD
- University of Washington, Department of Radiology, Seattle, WA
- University of Washington, Department of Global Health, Seattle, WA
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8
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Sood R, Rositch AF, Shakoor D, Ambinder E, Pool KL, Pollack E, Mollura DJ, Mullen LA, Harvey SC. Ultrasound for Breast Cancer Detection Globally: A Systematic Review and Meta-Analysis. J Glob Oncol 2020; 5:1-17. [PMID: 31454282 PMCID: PMC6733207 DOI: 10.1200/jgo.19.00127] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Mammography is not always available or feasible. The purpose of this systematic review and meta-analysis is to assess the diagnostic performance of ultrasound as a primary tool for early detection of breast cancer. MATERIALS AND METHODS For this systematic review and meta-analysis, we comprehensively searched PubMed and SCOPUS to identify articles from January 2000 to December 2018 that included data on the performance of ultrasound for detection of breast cancer. Studies evaluating portable, handheld ultrasound as an independent detection modality for breast cancer were included. Quality assessment and bias analysis were performed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Sensitivity analyses and meta-regression were used to explore heterogeneity. The study protocol has been registered with the international prospective register of systematic reviews (PROSPERO identifier: CRD42019127752). RESULTS Of the 526 identified studies, 26 were eligible for inclusion. Ultrasound had an overall pooled sensitivity and specificity of 80.1% (95% CI, 72.2% to 86.3%) and 88.4% (95% CI, 79.8% to 93.6%), respectively. When only low- and middle-income country data were considered, ultrasound maintained a diagnostic sensitivity of 89.2% and specificity of 99.1%. Meta-analysis of the included studies revealed heterogeneity. The high sensitivity of ultrasound for the detection of breast cancer was not statistically significantly different in subgroup analyses on the basis of mean age, risk, symptoms, study design, bias level, and study setting. CONCLUSION Given the increasing burden of breast cancer and infeasibility of mammography in certain settings, we believe these results support the potential use of ultrasound as an effective primary detection tool for breast cancer, which may be beneficial in low-resource settings where mammography is unavailable.
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Affiliation(s)
- Rupali Sood
- Johns Hopkins Medicine, Baltimore, MD.,RAD-AID International, Chevy Chase, MD
| | - Anne F Rositch
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Kara-Lee Pool
- RAD-AID International, Chevy Chase, MD.,University of California, Los Angeles, CA
| | - Erica Pollack
- RAD-AID International, Chevy Chase, MD.,Denver Health Medical Center, Denver, CO
| | | | | | - Susan C Harvey
- Johns Hopkins Medicine, Baltimore, MD.,RAD-AID International, Chevy Chase, MD
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9
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Nguyen DL, Ambinder EB, Jones MK, Mullen LA, Harvey SC. Improving State-Mandated Breast Density Notifications. J Am Coll Radiol 2020; 17:384-390. [DOI: 10.1016/j.jacr.2019.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/13/2019] [Accepted: 08/25/2019] [Indexed: 10/26/2022]
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10
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Walton WC, Kim SJ, Harvey SC, Mullen LA, Porter DW. Towards CNN-Based Registration of Craniocaudal and Mediolateral Oblique 2-D X-ray Mammographic Images. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2758-2764. [PMID: 31946465 DOI: 10.1109/embc.2019.8857853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We investigate methodologies for the automated registration of pairs of 2-D X-ray mammographic images, taken from the two standard mammographic angles. We present two exploratory techniques, based on Convolutional Neural Networks, to examine their potential for co-registration of findings on the two standard mammographic views. To test algorithm performance, our analysis uses a synthetic, surrogate data set for performing controlled experiments, as well as real 2-D X-ray mammogram imagery. The preliminary results are promising, and provide insights into how the proposed techniques may support multi-view X-ray mammography image registration currently and as technology evolves in the future.
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11
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Parekh VS, Macura KJ, Harvey SC, Kamel IR, EI‐Khouli R, Bluemke DA, Jacobs MA. Multiparametric deep learning tissue signatures for a radiological biomarker of breast cancer: Preliminary results. Med Phys 2020; 47:75-88. [PMID: 31598978 PMCID: PMC7003775 DOI: 10.1002/mp.13849] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/09/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Deep learning is emerging in radiology due to the increased computational capabilities available to reading rooms. These computational developments have the ability to mimic the radiologist and may allow for more accurate tissue characterization of normal and pathological lesion tissue to assist radiologists in defining different diseases. We introduce a novel tissue signature model based on tissue characteristics in breast tissue from multiparametric magnetic resonance imaging (mpMRI). The breast tissue signatures are used as inputs in a stacked sparse autoencoder (SSAE) multiparametric deep learning (MPDL) network for segmentation of breast mpMRI. METHODS We constructed the MPDL network from SSAE with 5 layers with 10 nodes at each layer. A total cohort of 195 breast cancer subjects were used for training and testing of the MPDL network. The cohort consisted of a training dataset of 145 subjects and an independent validation set of 50 subjects. After segmentation, we used a combined SAE-support vector machine (SAE-SVM) learning method for classification. Dice similarity (DS) metrics were calculated between the segmented MPDL and dynamic contrast enhancement (DCE) MRI-defined lesions. Sensitivity, specificity, and area under the curve (AUC) metrics were used to classify benign from malignant lesions. RESULTS The MPDL segmentation resulted in a high DS of 0.87 ± 0.05 for malignant lesions and 0.84 ± 0.07 for benign lesions. The MPDL had excellent sensitivity and specificity of 86% and 86% with positive predictive and negative predictive values of 92% and 73%, respectively, and an AUC of 0.90. CONCLUSIONS Using a new tissue signature model as inputs into the MPDL algorithm, we have successfully validated MPDL in a large cohort of subjects and achieved results similar to radiologists.
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Affiliation(s)
- Vishwa S. Parekh
- The Russell H. Morgan Department of Radiology and Radiological SciencesThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Department of Computer ScienceThe Johns Hopkins UniversityBaltimoreMD21208USA
| | - Katarzyna J. Macura
- The Russell H. Morgan Department of Radiology and Radiological SciencesThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Sidney Kimmel Comprehensive Cancer CenterThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
| | - Susan C. Harvey
- The Russell H. Morgan Department of Radiology and Radiological SciencesThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Hologic Inc36 Apple Ridge RdDanburyCT06810USA
| | - Ihab R. Kamel
- The Russell H. Morgan Department of Radiology and Radiological SciencesThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Sidney Kimmel Comprehensive Cancer CenterThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
| | - Riham EI‐Khouli
- The Russell H. Morgan Department of Radiology and Radiological SciencesThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Department of Radiology and Radiological SciencesUniversity of KentuckyLexingtonKY40536USA
| | - David A. Bluemke
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI53726USA
| | - Michael A. Jacobs
- The Russell H. Morgan Department of Radiology and Radiological SciencesThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Sidney Kimmel Comprehensive Cancer CenterThe Johns Hopkins University School of MedicineBaltimoreMD21205USA
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Nguyen DL, Ambinder EB, Jones MK, Hill G, Harvey SC. Improving Patient Comprehension of Screening Mammography Recall Lay Letters. J Am Coll Radiol 2019; 16:1669-1676. [DOI: 10.1016/j.jacr.2019.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
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13
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Stastna JJ, Yiapanas AD, Mandawala AA, Fowler KE, Harvey SC. Cryopreservation produces limited long-term effects on the nematode Caenorhabditis elegans. Cryobiology 2019; 92:86-91. [PMID: 31770528 DOI: 10.1016/j.cryobiol.2019.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022]
Abstract
Cryopreservation, the freezing and later warming of biological samples with minimal loss of viability, is important in many scientific disciplines. For some applications, particularly those where there is limited available material, it is critical to ensure the maximal survival rates of cryopreserved materials. Most of the challenges encountered with such techniques take place after the warming process where cryodamage affects cell viability and future development. Here we have used the nematode Caenorhabditis elegans to investigate the effects of cryodamage caused by slow-freezing. We find that freezing results in the death of some worms, with an approximately 40% reduction in the number of worms that develop in the frozen populations, but that the effects on worms that survive are limited. For example, there are no differences in the lifetime fecundity or in lifespan between frozen and control worms, although early fecundity and body size was reduced in frozen worms. Similarly, analyses of body wall muscle structure and of pharyngeal function indicates that muscle development and function are not significantly affected by freezing. We do however determine that freezing increases the rates of matricidal hatching, where progeny hatch within the mother. Overall, these results indicate that, for worms that survive, cryopreservation produces limited long-term effects, but do indicate that some phenotypes could be used in further analyses of the cellular damage induced by cryopreservation.
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Affiliation(s)
- J J Stastna
- Biomolecular Research Group, Canterbury Christ Church University, Canterbury, CT1 1QU, UK
| | - A D Yiapanas
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - A A Mandawala
- Biomolecular Research Group, Canterbury Christ Church University, Canterbury, CT1 1QU, UK
| | - K E Fowler
- Biomolecular Research Group, Canterbury Christ Church University, Canterbury, CT1 1QU, UK
| | - S C Harvey
- Biomolecular Research Group, Canterbury Christ Church University, Canterbury, CT1 1QU, UK.
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Hadley M, Mullen LA, Dickerson L, Harvey SC. Assessment and Improvement Strategies for a Breast Cancer Early Detection Program in Rural South Africa. J Glob Oncol 2019; 4:1-12. [PMID: 30085890 PMCID: PMC6223520 DOI: 10.1200/jgo.18.00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess and develop solutions for an ultrasound-based breast cancer early detection program in rural South Africa 1 year after implementation. Methods A WHO-endorsed RAD-AID Radiology Readiness Assessment was used to evaluate clinic resources. In addition, 5 weeks of observation identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders' input and the BI-RADS, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results Resource limitations included lack of computers, unpredictable electrical supply, and inconsistent Internet. The assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. Furthermore, limitations negatively affected communication among providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking data base compliant with BI-RADS. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent indicated positive general attitudes, and 100% agreed that the documentation system is easy and useful and improves overall quality of care, follow-up, decision making; access to clinical information; and communication between clinicians and patients. Five of the seven providers reported that the system increased visit time, but three of those five believed that the process was valuable. Conclusion Implementation of a breast cancer early detection program in resource-limited regions is challenging, and continual assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Future steps should focus on increasing efficiency, evaluation of provider attitudes long term, and clinical effect.
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Affiliation(s)
- Megan Hadley
- Megan Hadley and Lindsay Dickerson, The Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medicine, Baltimore, MD
| | - Lisa A Mullen
- Megan Hadley and Lindsay Dickerson, The Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medicine, Baltimore, MD
| | - Lindsay Dickerson
- Megan Hadley and Lindsay Dickerson, The Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medicine, Baltimore, MD
| | - Susan C Harvey
- Megan Hadley and Lindsay Dickerson, The Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medicine, Baltimore, MD
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15
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Honig EL, Mullen LA, Amir T, Alvin MD, Jones MK, Ambinder EB, Falomo ET, Harvey SC. Factors Impacting False Positive Recall in Screening Mammography. Acad Radiol 2019; 26:1505-1512. [PMID: 30772138 DOI: 10.1016/j.acra.2019.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/06/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES Our objective was to identify factors impacting false positive recalls in screening mammography. MATERIALS AND METHODS We retrospectively reviewed our screening mammography database from August 31, 2015 to September 30, 2016, including full field digital mammograms (FFDM) and digital breast tomosynthesis (DBT) mammograms. False positive (FP) exams were defined as Breast Imaging-Reporting and Data System (BI-RADS) 1 or 2 assessments at diagnostic imaging with 1 year cancer-free follow-up, Breast Imaging-Reporting and Data System 3 assessment at diagnostic imaging with 2 years cancer free follow-up, or biopsy with benign pathology. True positives were defined as malignant pathology on biopsy or surgical excision. We evaluated the association of FP recalls with multiple patient-level factors and imaging features. RESULTS A total of 22,055 screening mammograms were performed, and 1887 patients were recalled (recall rate 8.6%). Recall rate was lower for DBT than full field digital mammograms (8.0% vs 10.6%, p < 0.001). FP results were lower if prior mammograms were available (90.8% vs 95.8%, p = 0.02), and if there was a previous benign breast biopsy (87.6% vs 92.9%, p = 0.01). Mean age for the FP group was lower than the true positive group (56.1 vs 62.9 years, p < 0.001). There were no significant differences in FP recalls based on history of high-risk lesions, family history of breast or ovarian cancer, hormone use, breast density, race, or body mass index. CONCLUSION FP recalls were significantly less likely with DBT, in older women, in patients with prior mammograms available for comparison, and in patients with histories of benign breast biopsy. This study supports the importance of using DBT in the screening setting and obtaining prior mammograms for comparison.
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16
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Downs BM, Mercado-Rodriguez C, Cimino-Mathews A, Chen C, Yuan JP, Van Den Berg E, Cope LM, Schmitt F, Tse GM, Ali SZ, Meir-Levi D, Sood R, Li J, Richardson AL, Mosunjac MB, Rizzo M, Tulac S, Kocmond KJ, de Guzman T, Lai EW, Rhees B, Bates M, Wolff AC, Gabrielson E, Harvey SC, Umbricht CB, Visvanathan K, Fackler MJ, Sukumar S. DNA Methylation Markers for Breast Cancer Detection in the Developing World. Clin Cancer Res 2019; 25:6357-6367. [PMID: 31300453 DOI: 10.1158/1078-0432.ccr-18-3277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/04/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE An unmet need in low-resource countries is an automated breast cancer detection assay to prioritize women who should undergo core breast biopsy and pathologic review. Therefore, we sought to identify and validate a panel of methylated DNA markers to discriminate between cancer and benign breast lesions using cells obtained by fine-needle aspiration (FNA).Experimental Design: Two case-control studies were conducted comparing cancer and benign breast tissue identified from clinical repositories in the United States, China, and South Africa for marker selection/training (N = 226) and testing (N = 246). Twenty-five methylated markers were assayed by Quantitative Multiplex-Methylation-Specific PCR (QM-MSP) to select and test a cancer-specific panel. Next, a pilot study was conducted on archival FNAs (49 benign, 24 invasive) from women with mammographically suspicious lesions using a newly developed, 5-hour, quantitative, automated cartridge system. We calculated sensitivity, specificity, and area under the receiver-operating characteristic curve (AUC) compared with histopathology for the marker panel. RESULTS In the discovery cohort, 10 of 25 markers were selected that were highly methylated in breast cancer compared with benign tissues by QM-MSP. In the independent test cohort, this panel yielded an AUC of 0.937 (95% CI = 0.900-0.970). In the FNA pilot, we achieved an AUC of 0.960 (95% CI = 0.883-1.0) using the automated cartridge system. CONCLUSIONS We developed and piloted a fast and accurate methylation marker-based automated cartridge system to detect breast cancer in FNA samples. This quick ancillary test has the potential to prioritize cancer over benign tissues for expedited pathologic evaluation in poorly resourced countries.
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Affiliation(s)
- Bradley M Downs
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ashley Cimino-Mathews
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Jing-Ping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Eunice Van Den Berg
- Department of Anatomical Pathology, University of Witwaterstrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Leslie M Cope
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fernando Schmitt
- Medical Faculty of Porto University, Institute of Molecular Pathology and Immunology of Porto University, Porto, Portugal
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Syed Z Ali
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle Meir-Levi
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rupali Sood
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Juanjuan Li
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Andrea L Richardson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marina B Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Monica Rizzo
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | | | | | - Antonio C Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward Gabrielson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan C Harvey
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher B Umbricht
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kala Visvanathan
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Jo Fackler
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Saraswati Sukumar
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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17
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Ambinder EB, Mullen LA, Falomo E, Myers K, Hung J, Lee B, Harvey SC. Variability in Individual Radiologist BI-RADS 3 Usage at a Large Academic Center: What's the Cause and What Should We Do About It? Acad Radiol 2019; 26:915-922. [PMID: 30268720 DOI: 10.1016/j.acra.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES Although the breast imaging reporting and data system (BI-RADS) lists specific criteria for designating a lesion as BI-RADS category 3 (probably benign), there are no target benchmarks for BI-RADS 3 usage rates. This study investigates the variability of BI-RADS 3 rates among a group of academic breast imagers, with the goal of defining more precise utilization. MATERIALS AND METHODS We retrospectively reviewed all diagnostic mammograms performed between July 1, 2013 and August 8, 2017 at our academic institution. The percentage of diagnostic mammograms given a BI-RADS 3 assessment was compared between radiologists using the Chi-square test. We then evaluated for correlation between BI-RADS 3 rate and individual clinical metrics (eg, radiologist experience, cancer detection rate [CDR] and recall rate) using univariate linear regression. RESULTS The study included 13 breast imagers and 24,051 diagnostic breast examinations. There was significant variability in BI-RADS 3 rates between radiologists, ranging from 8.0% to 19.3% (p < 0.001). Increased BI-RADS 3 rates negatively correlated with BI-RADS 1 or 2 rate (p < 0.001) and positively correlated with recall rate (p = 0.03). There was no association between BI-RADS 3 rate and the radiologist's level of experience, BI-RADS 4 or 5 rate, or CDR. CONCLUSION We found significant variability in BI-RADS 3 usage, which seems to be used in place of BI-RADS 1 or 2 findings rather than to avoid biopsy recommendation. BI-RADS 3 rates also directly correlated with recall rate, suggesting a greater degree of uncertainty among specific radiologists. Importantly, increased usage of BI-RADS 3 did not correlate with provider experience or improved CDR.
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18
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Woods RW, Camp MS, Durr NJ, Harvey SC. A Review of Options for Localization of Axillary Lymph Nodes in the Treatment of Invasive Breast Cancer. Acad Radiol 2019; 26:805-819. [PMID: 30143401 DOI: 10.1016/j.acra.2018.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 02/09/2023]
Abstract
Invasive breast cancer is a common disease, and the most common initial site of metastatic disease are the axillary lymph nodes. As the standard of care shifts towards less invasive surgery in the axilla for patients with invasive breast cancer, techniques have been developed for axillary node localization that allow targeted dissection of specific lymph nodes without requiring full axillary lymph node dissection. Many of these techniques have been adapted from technologies developed for localization of lesions within the breast and include marker clip placement with intraoperative ultrasound, carbon-suspension liquids, localization wires, radioactive seeds, magnetic seeds, radar reflectors, and radiofrequency identification devices.The purpose of this article is to summarize these methods and describe benefits and drawbacks of each method for performing localization of lymph nodes in the axilla.
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19
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Ambinder EB, Mullen LA, Shakoor D, Falomo E, Harvey SC. Changes in Final BI-RADS Assessment Categories and Clinical Outcome Metrics When Digital Breast Tomosynthesis Is Included in Diagnostic Mammography. J Am Coll Radiol 2019; 16:728-732. [PMID: 30661997 DOI: 10.1016/j.jacr.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Emily B Ambinder
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lisa A Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Delaram Shakoor
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Eniola Falomo
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Susan C Harvey
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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20
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Harvey SC, Mullen LA. The Importance of Understanding Breast Cancer in Pregnancy. J Womens Health (Larchmt) 2019; 28:737-738. [PMID: 30864891 DOI: 10.1089/jwh.2018.7622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Susan C Harvey
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
| | - Lisa Ann Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, Maryland
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21
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Mullen LA, Harvey SC. Review of axillary web syndrome: What the radiologist should know. Eur J Radiol 2019; 113:66-73. [PMID: 30927961 DOI: 10.1016/j.ejrad.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
Axillary web syndrome is common after axillary surgery, frequently affecting breast cancer patients. In this condition, patients develop one or more linear bands of firm tissue, also known as "cords", in the axilla and arm, associated with pain and limited range of motion of the shoulder and arm. Radiologists may encounter this syndrome in patients referred for axillary or upper extremity ultrasound, and should be aware of the physical examination and ultrasound findings for accurate diagnosis. However, there are currently limited articles about this syndrome published in radiology journals, suggesting that radiologists may be unaware of this entity. In this work, axillary web syndrome will be discussed, including background knowledge, incidence, clinical presentation, possible etiology, and ultrasound appearance.
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Affiliation(s)
- Lisa A Mullen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
| | - Susan C Harvey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
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22
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Panigrahi B, Harvey SC, Mullen LA, Falomo E, Di Carlo P, Lee B, Myers KS. Characteristics and Outcomes of BI-RADS 3 Lesions on Breast MRI. Clin Breast Cancer 2019; 19:e152-e159. [DOI: 10.1016/j.clbc.2018.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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23
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Dickerson LK, Rositch AF, Lucas S, Mullen LA, Harvey SC. An Educational Intervention and Feasibility Assessment of Breast Ultrasound in Rural South Africa. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Breast cancer is the leading cause of cancer death in women worldwide, with a strikingly high mortality in low- and middle-income countries (LMICs) as a result of the scarcity of detection, diagnosis, and treatment. With mammography unavailable, ultrasound (US) offers a viable alternative. The literature reports successful training in various domains, but a curriculum focused on the breast is novel. We assessed the feasibility—knowledge acquisition, perceived utility, and self-efficacy—of a breast US training program for the detection of breast cancer by nonphysician providers. Methods Training was implemented for 12 providers, including professional nurses, nursing assistants, and lay counselors, at Hlokomela clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey (n = 12) that characterized providers’ initial attitudes toward early detection and a pretest (n = 12) that determined immediate retention of knowledge and areas for focused training. All providers received hands-on training with nurses as models. Five providers trained with patients. A post-test (n = 12) assessed overall knowledge retention and acquisition, and a postsurvey (n = 10) gauged program acceptance and provider self-efficacy with breast US. Results Pretest to post-test averages improved by 68% overall and in four competencies—foundational knowledge, descriptive categories, benign versus malignant, and lesion identification. On the postsurvey, providers expressed the belief that US could significantly affect breast cancer detection (9.1/10), treatment (7.9/10), and survival (8.7/10) in their communities and endorsed moderate confidence in their scanning (6.3/10) and interpreting abilities (5.6/10). Conclusion There is a pressing need for a paradigm shift in breast cancer care in LMICs, with early detection critical to improving outcomes. Our research supports the feasibility of breast US training as part of a breast education program in LMICs. Pretest and post-test results and observed proficiency indicate that training nonphysician providers is achievable. Postsurvey responses indicate program acceptance, provider self-efficacy with US, and community-based ownership of a breast cancer screening and awareness initiative. Follow-up work that is focused on quality improvement and sustainability is ongoing. Future work may show that breast US is viable for early detection when mammography is unavailable. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Susan C. Harvey Consulting or Advisory Role: IBM Watson, Hologic Inc Research Funding: IBM Watson
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Affiliation(s)
- Lindsay K. Dickerson
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Anne F. Rositch
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Susan Lucas
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Lisa A. Mullen
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Susan C. Harvey
- Lindsay K. Dickerson, Johns Hopkins University School of Medicine; Anne F. Rositch, Johns Hopkins Bloomberg School of Public Health; Lisa A. Mullen and Susan C. Harvey, Johns Hopkins Medical Institutions, Baltimore, MD; and Susan Lucas, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
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24
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Hadley ME, Mullen LA, Dickerson L, Harvey SC. Assessment and Improvement Strategies for a Breast Cancer Early Detection Program in Rural South Africa. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.10180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose More than one half of breast cancer deaths occur in low- and middle-income countries, where survival rates are 60% at best. Appropriate programs that improve detection, diagnosis, and treatment in low- and middle-income countries are essential to improving breast cancer outcomes. The sustainability of such programs requires ongoing efforts, yet there remains a lack of literature on follow-up to assure long-term program success. Our study aimed to understand what needs developed in the year after the implementation of an early detection program and to evaluate potential solutions. Methods A WHO-endorsed RAD-AID Radiology Readiness Assessment evaluated clinic resources. In addition, in 5 weeks of observation we identified resource deficiencies and reviewed existing documentation methods. On the basis of stakeholders’ input and the Breast Imaging Reporting and Data System, we developed new documentation systems. Training was followed by a survey that assessed feasibility and provider acceptance. Results Resource limitations included a lack of computers, unpredictable electrical supply, and inconsistent Internet. Assessment revealed incomplete documentation of breast clinical examinations and history, breast lesions, and follow-up. In addition, limitations negatively impacted communication between providers. Three solutions were developed: a paper patient history form, a paper clinical findings form, and a computerized patient-tracking database that was compliant with the Breast Imaging Reporting and Data System. Three nurses, three nursing assistants, and one counselor completed the survey. Seventy-one percent (five of seven respondents) indicated positive or very positive general attitudes. One hundred percent of respondents agreed or strongly agreed to the following statement: the documentation system is easy, useful, and improves overall quality of care, follow-up, decision making, access to clinical information, and communication between clinicians and patients. Five of seven providers reported that the system increased visit time, but three of these five felt that the process was valuable. Conclusion Implementing a breast cancer early detection program in resource-limited regions is challenging and continued assessment is essential. As a result of identified needs, we developed a documentation system that was broadly accepted. Potential future steps should focus on increasing efficiency, evaluating provider attitudes on a long-term basis, and clinical impact. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Susan C. Harvey Honoraria: Hologic Inc, IBM Watson Imaging Consulting or Advisory Role: IBM Watson, Hologic Inc Research Funding: IBM Watson
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Affiliation(s)
- Megan E. Hadley
- Megan E. Hadley and Lindsay Dickerson, Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lisa A. Mullen
- Megan E. Hadley and Lindsay Dickerson, Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lindsay Dickerson
- Megan E. Hadley and Lindsay Dickerson, Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Susan C. Harvey
- Megan E. Hadley and Lindsay Dickerson, Johns Hopkins University School of Medicine; and Lisa A. Mullen and Susan C. Harvey, The Johns Hopkins Medical Institutions, Baltimore, MD
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25
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Sujlana PS, Mahesh M, Vedantham S, Harvey SC, Mullen LA, Woods RW. Digital breast tomosynthesis: Image acquisition principles and artifacts. Clin Imaging 2018; 55:188-195. [PMID: 30236642 DOI: 10.1016/j.clinimag.2018.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/26/2018] [Accepted: 07/16/2018] [Indexed: 11/16/2022]
Abstract
Digital breast tomosynthesis (DBT) is a new technology that is being used more frequently for both breast cancer screening and diagnostic purposes and its utilization is likely to continue to increase over time. The major benefit of tomosynthesis over 2D-mammography is that it allows radiologists to view breast tissue using a three-dimensional dataset and improves diagnostic accuracy by facilitating differentiation of potentially malignant lesions from overlap of normal tissue. In addition, image processing techniques allow reconstruction of two dimensional synthesized mammograms (SM) from DBT data, which eliminates the need for acquiring two dimensional full field digital mammography (FFDM) in addition to tomosynthesis and thereby reduces the radiation dose. DBT systems incorporate a moveable x-ray tube, which moves in a prescribed way over a limited angular range to obtain three-dimensional data of patients' breasts, and utilize reconstruction algorithms. The limited angular range for DBT leads to incomplete sampling of the object, and a movable x-ray tube prolongs the imaging time, both of which make DBT and SM susceptible to artifacts. Understanding the etiology of these artifacts should help radiologists in reducing the number of artifacts and in differentiating a true finding from one related to an artifact, thus potentially decreasing recall rates and false positive rates. This is becoming especially important with increased incorporation of DBT in practices around the world. The goal of this article is to review the physics principles behind DBT systems and use these principles to explain the origin of artifacts that can limit diagnostic evaluation.
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Affiliation(s)
- Parvinder S Sujlana
- Johns Hopkins Medical Institutions, The Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Wolfe Street, Baltimore, MD 21287, United States of America
| | - Mahadevappa Mahesh
- Johns Hopkins Medical Institutions, The Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Wolfe Street, Baltimore, MD 21287, United States of America
| | - Srinivasan Vedantham
- University of Arizona - Banner University Medical Center, 1609 N. Warren Ave, Tucson, AZ 85719, United States of America
| | - Susan C Harvey
- Johns Hopkins Medical Institutions, The Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Wolfe Street, Baltimore, MD 21287, United States of America
| | - Lisa A Mullen
- Johns Hopkins Medical Institutions, The Russell H. Morgan Department of Radiology and Radiological Science, 601 N. Wolfe Street, Baltimore, MD 21287, United States of America
| | - Ryan W Woods
- University of Wisconsin School of Medicine and Public Health, Department of Radiology, 600 Highland Avenue, Madison, WI 53792, United States of America.
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Ambinder EB, Harvey SC, Panigrahi B, Li X, Woods RW. Synthesized Mammography: The New Standard of Care When Screening for Breast Cancer with Digital Breast Tomosynthesis? Acad Radiol 2018; 25:973-976. [PMID: 29395801 DOI: 10.1016/j.acra.2017.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/10/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES This study aims to evaluate the screening performance of digital breast tomosynthesis (DBT) combined with synthesized mammography (SM) vs combined with full-field digital mammography (FFDM). MATERIALS AND METHODS We retrospectively reviewed all screening studies utilizing FFDM + DBT (n = 7845) and SM + DBT (n = 14,776) between April 1, 2013, and February 15, 2016. Recall rate, biopsy rate, positive predictive value 1 (PPV1), positive predictive value 3 (PPV3), and cancer detection rate (CDR) were compared between the two groups. A generalized linear mixed model specifying the reading radiologist as the random effect and controlling for age was used to compare clinical outcomes between the two groups. RESULTS The overall recall rate was significantly lower in the SM + DBT cohort compared to the FFDM + DBT cohort (7.06% vs 7.63%, P = .04). There was no difference in biopsy rate, PPV1, PPV3, or CDR between the two groups. CONCLUSIONS When DBT is performed for screening, the use of SM rather than acquiring an additional FFDM has no significant effect on biopsy rate, PPV1, PPV3, or CDR. We found a decrease in recall rate in the SM + DBT group, which may be related to the learning curve of interpreting DBT. These findings support the use of SM for patients undergoing screening with DBT.
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27
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Downs BM, Fackler MJ, Mercado-Rodriguez C, Cimino-Mathews A, Chen C, Yuan JP, Berg EVD, Cope LM, Harvey SC, Ali SZ, Tulac S, Kocmond KJ, Lai EW, Rhees B, Bates M, Sukumar S. Abstract LB-220: An automated breast cancer detection assay for screening in the developing world. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Breast cancer incidence is rapidly increasing globally with 1.7 million new cases and 600,000 deaths due to the disease annually. Death due to breast cancer is four to six times more frequent in the developing world compared to the USA due to lack of early detection, definitive diagnosis, and limited access to treatment. Ultrasound imaging for early detection and ultrasound guided fine needle aspiration (FNA) of suspicious lesions followed by an automated, cartridge-based analysis of methylated genes could triage malignancies for faster pathology assessment and treatment, thus enabling better use of scarce resources.
Experimental Procedures: To identify a panel of methylated DNA markers to enable sensitive and specific detection of malignant breast lesions, we screened 24 methylated genes (known to be frequently methylated in malignant breast tissue and unmethylated in normal breast tissue) by Quantitative Multiplex Methylation-Specific PCR (QM-MSP) analysis. Formalin-fixed paraffin-embedded (FFPE) sections of biopsies of both benign and malignant breast lesions from the USA, China and South Africa were analyzed. Samples were divided into Training and Test sets. The Training set consisted of 206 tissues [66 invasive ductal carcinoma (IDC), 30 ductal carcinoma in situ (DCIS), 99 benign breast disease (BBD) and 11 normal breast (NB)]. The gene panel selected in the Training set was examined in an independent Test set of tissues (n=204) [65 IDC, 29 DCIS, 99 BBD and 11 NB]. Further, we optimized the technical performance of an automated, prototype breast cancer detection cartridge system for quantitative assessment of gene methylation and tested it in pilot study using FNA samples from breast cancers.
Results: Analysis of the tissues in the Training set (n=206) led to the selection of a panel of 10 genes highly methylated in malignant lesions with little or no methylation in benign lesions. For the 10-gene panel to achieve a sensitivity greater than 90%, a laboratory cutoff of 14.5 cumulative methylation (CM) units (out of a possible 10,000 units) was set. In the Training set, the 10-gene panel achieved a sensitivity of 90% and a specificity of 85% with receiver operating characteristic (ROC) statistics: ROC, AUC= 0.947. In a blinded Test set of tissue samples (n=204), with a laboratory cutoff of 14.5 CM units, the 10-gene panel achieved a sensitivity of 87% and a specificity of 89%, with ROC statistics: p<0.001, AUC= 0.936, and provided significant accuracy for breast cancers from three countries and all molecular subtypes. In a pilot study of FNA samples using the cartridge system, robust methylation in all ten genes was detected in malignant tumors.
Conclusions: QM-MSP of breast lesions led to the selection of a panel of 10 genes methylated for detection of breast cancer. We have validated the technical performance of an automated, prototype cartridge system. The study reveals the potential of methylation markers to provide fast, accurate and automated cancer detection at a low cost in developing regions globally.
Research Use Only. Not for diagnostic tests.
A sponsored research agreement from Cepheid to Dr. Sukumar's Lab at Johns Hopkins University.
Citation Format: Bradley M. Downs, Mary Jo Fackler, Claudia Mercado-Rodriguez, Ashley Cimino-Mathews, Chuang Chen, Jing-Ping Yuan, Eunice van den Berg, Leslie M. Cope, Susan C. Harvey, Syed Z. Ali, Suzana Tulac, Kriszten J. Kocmond, Edwin W. Lai, Brian Rhees, Mike Bates, Saraswati Sukumar. An automated breast cancer detection assay for screening in the developing world [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-220.
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Affiliation(s)
| | | | | | | | - Chuang Chen
- 2Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Eunice van den Berg
- 3National Health Laboratory Service and University of the Witwatersrand, Sandringham, South Africa
| | | | | | - Syed Z. Ali
- 1Johns Hopkins Univ. School of Medicine, Baltimore, MD
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Smith EG, Davis K, Sulsh L, Harvey SC, Fowler KE. Canine recommended breed weight ranges are not a good predictor of an ideal body condition score. J Anim Physiol Anim Nutr (Berl) 2018; 102:1088-1090. [PMID: 29737554 DOI: 10.1111/jpn.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
Breed-specific ideal bodyweight range information is widely used by dog owners and breeders as a guideline to ensure animals are within a healthy weight range. Body Condition Scoring, a method used by veterinarians to assess an animal's overall shape with regard to weight is considered to be an excellent method to determine an animal's overall body condition; these values, however, do not always correspond to published weight ranges. Here, the weight, neuter status, age and a nine-point Body Condition Score of a population of 140 purebred dogs were recorded and subsequently analysed to determine whether bodyweight was an effective predictor for Body Condition Scores. This comparison indicated that published recommended, breed-specific body weight ranges are not a good predictor for an ideal BCS and as such, guidelines for owners and breeders need to be systematically reviewed.
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Affiliation(s)
- E G Smith
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - K Davis
- Portland Road Veterinary Surgery, West Sussex, UK
| | - L Sulsh
- Portland Road Veterinary Surgery, West Sussex, UK
| | - S C Harvey
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - K E Fowler
- School of Human and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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Salas Fragomeni RA, Amir T, Sheikhbahaei S, Harvey SC, Javadi MS, Solnes LB, Kiess AP, Allaf ME, Pomper MG, Gorin MA, Rowe SP. Imaging of Nonprostate Cancers Using PSMA-Targeted Radiotracers: Rationale, Current State of the Field, and a Call to Arms. J Nucl Med 2018; 59:871-877. [PMID: 29545375 DOI: 10.2967/jnumed.117.203570] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/23/2018] [Indexed: 11/16/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein that is highly overexpressed on prostate cancer epithelial cells and for which there is a growing body of literature examining the role of small-molecule and antibody radiotracers targeted against this protein for prostate cancer detection and therapy. Despite its name, PSMA is also expressed, to varying degrees, in the neovasculature of a wide variety of nonprostate cancers; indeed, the pathology literature is replete with promising immunohistochemistry findings. Several groups have begun to correlate those pathology-level results with in vivo imaging and therapy in nonprostate cancers using the same PSMA-targeted agents that have been so successful in prostate cancer. The potential to leverage radiotracers targeted to PSMA beyond prostate cancer is a promising approach for many cancers, and PSMA-targeted agents may be able to supplement or fill gaps left by other agents. However, to date, most of the reported findings with PSMA-targeted radiotracers in nonprostate malignancies have been in case reports and small case series, and the field must adopt a more thorough approach to the design and execution of larger prospective trials to realize the potential of these promising agents outside prostate cancer.
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Affiliation(s)
- Roberto A Salas Fragomeni
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tali Amir
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara Sheikhbahaei
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Susan C Harvey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mehrbod S Javadi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lilja B Solnes
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin G Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael A Gorin
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.,James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven P Rowe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland .,James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Mullen LA, Panigrahi B, Hollada J, Panigrahi B, Falomo ET, Harvey SC. Strategies for Decreasing Screening Mammography Recall Rates While Maintaining Performance Metrics. Acad Radiol 2017; 24:1556-1560. [PMID: 28760363 DOI: 10.1016/j.acra.2017.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/14/2017] [Accepted: 06/08/2017] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVE This study aimed to determine the impact of interventions designed to reduce screening mammography recall rates on screening performance metrics. MATERIALS AND METHODS We assessed baseline performance for full-field digital mammography (FFDM) and digital breast tomosynthesis mammography (DBT) for a 3-year period before intervention. The first intervention sought to increase awareness of recalls from screening mammography. Breast imagers discussed their perceptions regarding screening recalls and were required to review their own recalled cases, including outcomes of diagnostic evaluation and biopsy. The second intervention implemented consensus double reading of all recalls, requiring two radiologists to agree if recall was necessary. Recall rates, cancer detection rates, and positive predictive value 1 (PPV1) were compared before and after each intervention. RESULTS The baseline recall rate, cancer detection rate, and PPV1 were 11.1%, 3.8/1000, and 3.4%, respectively, for FFDM, and 7.6%, 4.8/1000, and 6.0%, respectively, for DBT. Recall rates decreased significantly to 9.2% for FFDM and to 6.6% for DBT after the first intervention promoting awareness, as well as to 9.9% for FFDM after the second intervention implementing group consensus. PPV1 increased significantly to 5.7% for FFDM and to 9.0% for DBT after the second intervention. Cancer detection rate did not significantly change with the implementation of these interventions. An average of 2.3 minutes was spent consulting for each recall. CONCLUSION Reduction in recall rates is desirable, provided performance metrics remain favorable. Our interventions improved performance and could be implemented in other breast imaging settings.
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Affiliation(s)
- Lisa A Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287
| | - Babita Panigrahi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287
| | - Jacqueline Hollada
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Eniola T Falomo
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287
| | - Susan C Harvey
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287.
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Holz K, Harvey SC, Alvin MD, Beach MC, Pisano K, Woods R. Communication in Breast Imaging: Lessons Learned at Diagnostic Evaluation. J Am Coll Radiol 2017; 14:665-667. [DOI: 10.1016/j.jacr.2016.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 10/16/2016] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
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Dickerson LK, Rositch AF, Lucas S, Harvey SC. Pilot Educational Intervention and Feasibility Assessment of Breast Ultrasound in Rural South Africa. J Glob Oncol 2017; 3:502-508. [PMID: 29094089 PMCID: PMC5646899 DOI: 10.1200/jgo.2016.008086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Breast cancer is the leading cause of cancer death in women worldwide, with high mortality in low- and middle-income countries because of a lack of detection, diagnosis, and treatment. With mammography unavailable, ultrasound offers an alternative for downstaging. The literature reports successful training in various domains, but a focus on the breast is novel. We assessed the feasibility (knowledge acquisition, perceived usefulness, and self-efficacy) of breast ultrasound training for nonphysician providers. Methods Training was implemented for 12 providers at Hlokomela Clinic in Hoedspruit, South Africa, over 3 weeks. Didactic presentations and example cases were followed by a presurvey and test (n = 12). All providers received hands-on training with nurses as models; five providers trained with patients. A post-test (n = 12) assessed knowledge acquisition and a postsurvey (n = 10) assessed perceived program usefulness and provider self-efficacy. Results The pre- to post-test averages improved by 68% in total and in four competencies (foundational knowledge, descriptive categories, benign v malignant, and lesion identification). On the postsurvey, providers expressed that ultrasound could significantly influence breast cancer detection (9.1 out of 10), treatment (7.9 out of 10), and survival (8.7 out of 10) in their community and endorsed moderate confidence in their scanning (6.3 out of 10) and interpreting abilities (5.6 out of 10). Conclusion Our research supports the feasibility of breast ultrasound training as part of a breast education program in low- and middle-income countries. Pre- and post-test results and observed proficiency indicate that training nonphysician providers is achievable; postsurvey responses indicate program acceptance, community-based ownership, and provider self-efficacy with ultrasound. Future work may show that breast ultrasound is viable for early detection where mammography is unavailable.
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Affiliation(s)
- Lindsay K Dickerson
- , Johns Hopkins University School of Medicine; , Johns Hopkins Bloomberg School of Public Health; , Johns Hopkins Medical Institutions, Baltimore, MD; and , Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Anne F Rositch
- , Johns Hopkins University School of Medicine; , Johns Hopkins Bloomberg School of Public Health; , Johns Hopkins Medical Institutions, Baltimore, MD; and , Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan Lucas
- , Johns Hopkins University School of Medicine; , Johns Hopkins Bloomberg School of Public Health; , Johns Hopkins Medical Institutions, Baltimore, MD; and , Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
| | - Susan C Harvey
- , Johns Hopkins University School of Medicine; , Johns Hopkins Bloomberg School of Public Health; , Johns Hopkins Medical Institutions, Baltimore, MD; and , Chris Hani Baragwanath Academic Hospital, University of Witwatersrand School of Medicine, Johannesburg, South Africa
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Abstract
Purpose Breast cancer survival is unacceptably low in many low-resource settings, including rural South Africa, where access to screening and treatment services is limited. To describe the context for implementing an early detection program, we assessed knowledge and attitudes toward breast cancer risk, early detection, and treatment. Methods We conducted a cross-sectional survey among 243 women presenting to Hlokomela Clinic in Hoedspruit, South Africa, during April and May 2016. We used quantitative and qualitative analyses to determine levels of knowledge of risk factors, symptoms, and treatment of breast cancer, as well as experience with and attitudes toward detection and treatment methods. Results Thirty-one percent of women correctly identified at least six of 12 risk factors for breast cancer, and 53.1% identified breast lumps as an important symptom. Although > 97% of women stated that self–breast examination and early detection were highly important and that they would seek care for changes in their breasts, only 33.3% of women reported performing self–breast examination, and only 24.3% reported receiving a clinical breast examination. Age and education were not associated with knowledge, and level of knowledge did not predict care-seeking behaviors or attitudes. Conclusion Although women demonstrated moderate levels of knowledge of breast cancer symptoms and risk factors and the importance of early detection, few women reported seeking services. These data demonstrate sufficient levels of knowledge and positive attitudes toward care seeking and suggest both a need and readiness for increased access to cost-effective services to facilitate early diagnosis and improved outcomes.
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Affiliation(s)
- Lydia A Trupe
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Anne Rositch
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Lindsay Dickerson
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Su Lucas
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Susan C Harvey
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
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Narayan AK, Harvey SC, Durand DJ. Impact of Medicare Shared Savings Program Accountable Care Organizations at Screening Mammography: A Retrospective Cohort Study. Radiology 2017; 282:437-448. [DOI: 10.1148/radiol.2016160554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Harvey SC, Di Carlo PA, Lee B, Obadina E, Sippo D, Mullen L. An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources. J Am Coll Radiol 2016; 13:R74-R80. [DOI: 10.1016/j.jacr.2016.09.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Narayan AK, Visvanathan K, Harvey SC. Comparative effectiveness of breast MRI and mammography in screening young women with elevated risk of developing breast cancer: a retrospective cohort study. Breast Cancer Res Treat 2016; 158:583-9. [PMID: 27444927 DOI: 10.1007/s10549-016-3912-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/25/2022]
Abstract
Screening guidelines recommend that women with 20 % or greater lifetime risk of breast cancer undergo annual breast MRI screening to supplement mammography, irrespective of age. In patients less than 40 years, mammography is often avoided due to concerns about radiation and decreased performance. However, prior studies have been limited by large percentages of women above 40 with decreased breast density. Our purpose was to test whether adding mammography to breast MRI screening compared to breast MRI screening alone in women below 40 increases cancer detection rates. After obtaining IRB approval, chart review identified patients aged 25-40 years undergoing breast MR screening (2005-2014). Demographics, risk factors, BI-RADS assessments, background parenchymal enhancement, and mammographic breast tissue density were recorded. Cancer detection rates, short-term follow-up (BIRADS 3), image-guided biopsy (BIRADS 4,5), and PPV1-3 were calculated. 342 breast MRI exams were identified (average age was 33, 37 % were nulliparous, and 64 % had prior benign biopsy), 226 (66 %) of which underwent concurrent mammography. Risk factors included 64 % with breast cancer in first-degree relative(s), 90 % had heterogeneous or extremely dense breast tissue on mammography, and 16 % were BRCA carriers. Four invasive cancers were detected by MRI (11.7 cancers/1000 examinations, 95 % CI 8.3, 15.1). None of these was detected by mammography, and no cancers were independently identified by mammography. Breast MRI screening in high-risk women under 40 yielded elevated cancer detection rates (11.7/1000). The cancer detection rate for mammography was 0 %, suggesting that MRI alone may be useful in screening high-risk women under 40.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, 615 N. Wolfe St., Room E6142, Baltimore, MD, 21205, USA
| | - Susan C Harvey
- Department of Radiology, Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD, 21287, USA
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Mobbs LM, Jannicky EAS, Weaver DL, Harvey SC. The Accuracy of Sonography in Detecting Abnormal Axillary Lymph Nodes When Breast Cancer Is Present. Journal of Diagnostic Medical Sonography 2016. [DOI: 10.1177/8756479305278268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated the accuracy of sonography in detecting abnormal ipsilateral axillary lymph nodes in women with breast cancer. The authors retrospectively reviewed the sonographic findings and surgical pathology reports of 71 women who were diagnosed with breast cancer by ultrasound-guided biopsies. Results found in 71 cases that the sonographic specificity was 82%, whereas the sensitivity was only 40%. In 8 of the 17 cases (47%), sonography was suspicious for cancer, and the final surgical pathology was malignant. In 42 of 54 cases (77%), sonography of the axilla was not suspicious, and the final axillary node surgical pathology was negative. In 12 cases, sonographic images of the lymph nodes appeared normal, whereas the surgical pathology of the axillary nodes demonstrated malignancy. Ultrasound imaging has a high specificity when evaluating axillary lymph nodes and can be recommended when a suspicious finding is detected in the breast during diagnostic breast sonographic examination.
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Affiliation(s)
- Louise M. Mobbs
- Department of Radiology, Fletcher Allen Health Care, Breast Ultrasound Division, Burlington, VT,
| | | | | | - Susan C. Harvey
- Department of Radiology, University of Vermont, Burlington, VT
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Hodgson R, Heywang-Köbrunner SH, Harvey SC, Edwards M, Shaikh J, Arber M, Glanville J. Systematic review of 3D mammography for breast cancer screening. Breast 2016; 27:52-61. [DOI: 10.1016/j.breast.2016.01.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/23/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022] Open
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Harvey SC, Wolff AC. Does a Picture Make a Difference? Ultrasound Guidance in the Management of the Axilla After Neoadjuvant Chemotherapy. J Clin Oncol 2015; 33:3367-9. [DOI: 10.1200/jco.2014.60.1112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Susan C. Harvey
- The Johns Hopkins University School of Medicine, Baltimore, MD
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Sippo DA, Kulkarni K, Carlo PD, Lee B, Eisner D, Cimino-Mathews A, Harvey SC. Metastatic Disease to the Breast From Extramammary Malignancies: A Multimodality Pictorial Review. Curr Probl Diagn Radiol 2015; 45:225-32. [PMID: 26293973 DOI: 10.1067/j.cpradiol.2015.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
Abstract
This pictorial review demonstrates imaging features of extramammary malignancies metastatic to the breast seen with multiple modalities, including mammography, ultrasound, computed tomography (CT), positron emission tomography, and magnetic resonance imaging. Although rare, metastases to the breast may have a distinct imaging appearance from the appearance of primary breast cancers. They are important to identify because they can mimic benign breast disease and their treatment differs from that of primary breast cancer. Metastatic disease to the breast most commonly appears as a single round or oval mass with circumscribed margins. Sonographically it is usually hypoechoic, and with CT or magnetic resonance imaging it usually enhances. In contrast with primary breast cancer, breast metastases do not demonstrate spiculated margins and rarely have associated calcifications. A variety of clinical presentations of breast metastases are reviewed, including presentation with a palpable mass, detection at screening mammography, and detection with CT or positron emission tomography.
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Affiliation(s)
- Dorothy A Sippo
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Kopal Kulkarni
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Philip Di Carlo
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bonmyong Lee
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Eisner
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Susan C Harvey
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
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Harvey SC, Vegesna A, Mass S, Clarke J, Skoufalos A. Understanding patient options, utilization patterns, and burdens associated with breast cancer screening. J Womens Health (Larchmt) 2014; 23 Suppl 1:S3-9. [PMID: 25247383 DOI: 10.1089/jwh.2014.1510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite ongoing awareness, educational campaigns, and advances in technology, breast cancer screening remains a complex topic for women and for the health care system. Lack of consensus among organizations developing screening guidelines has caused confusion for patients and providers. The psychosocial factors related to breast cancer screening are not well understood. The prevailing algorithm for screening results in significant rates of patient recall for further diagnostic imaging or procedures, the majority of which rule out breast cancer rather than confirming it. For women, the consequences of the status quo range from unnecessary stress to additional out-of-pocket expenses to indirect costs that are more difficult to quantify. A more thoughtful approach to breast cancer screening, coupled with a research agenda that recognizes the indirect and intangible costs that women bear, is needed to improve cost and quality outcomes in this area.
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Affiliation(s)
- Susan C Harvey
- 1 The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions , Baltimore, Maryland
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Green JWM, Snoek LB, Kammenga JE, Harvey SC. Genetic mapping of variation in dauer larvae development in growing populations of Caenorhabditis elegans. Heredity (Edinb) 2013; 111:306-13. [PMID: 23715016 PMCID: PMC3807260 DOI: 10.1038/hdy.2013.50] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 11/09/2022] Open
Abstract
In the nematode Caenorhabditis elegans, the appropriate induction of dauer larvae development within growing populations is likely to be a primary determinant of genotypic fitness. The underlying genetic architecture of natural genetic variation in dauer formation has, however, not been thoroughly investigated. Here, we report extensive natural genetic variation in dauer larvae development within growing populations across multiple wild isolates. Moreover, bin mapping of introgression lines (ILs) derived from the genetically divergent isolates N2 and CB4856 reveals 10 quantitative trait loci (QTLs) affecting dauer formation. Comparison of individual ILs to N2 identifies an additional eight QTLs, and sequential IL analysis reveals six more QTLs. Our results also show that a behavioural, laboratory-derived, mutation controlled by the neuropeptide Y receptor homolog npr-1 can affect dauer larvae development in growing populations. These findings illustrate the complex genetic architecture of variation in dauer larvae formation in C. elegans and may help to understand how the control of variation in dauer larvae development has evolved.
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Affiliation(s)
- J W M Green
- Ecology Research Group, Department of Geographical and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - L B Snoek
- Laboratory of Nematology, Wageningen University, Wageningen, The Netherlands
| | - J E Kammenga
- Laboratory of Nematology, Wageningen University, Wageningen, The Netherlands
| | - S C Harvey
- Ecology Research Group, Department of Geographical and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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Abstract
A computer program has been written to simulate the Brownian motion of rigid fluorescent molecules. The time dependence of the fluorescence polarization anisotropy as generated by this simulation is in agreement with that predicted by the recent theoretical treatment of Belford, Belford, and Weber (Proc. Nat. Acad. Sci. USA (1972) 69, 1392-1393). The program thus serves as a verification of their equation. It is being generalized to cover the case of nonrigid molecules.
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Affiliation(s)
- S C Harvey
- Department of Engineering Biophysics, University of Alabama Medical Center, Birmingham, Ala. 35294
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Abstract
The velocity curve of fibroplasia in the healing of wounds in young rats reached its end-point 3 days ahead of a similar curve for adults. Strength and fibroplasia were manifest 1 day sooner than in the adults. A study of the increments of the curve showed that the rate of fibroplasia during the accelerated phase was less in the young and that it lasted longer. Correspondingly, retardation appeared later and was less in amount than in the curve for the adult rats. The amount of retardation was even less than in the curve obtained for adults on a high protein diet, in spite of the fact that in this latter curve there was a definite increase in the rate of fibroplasia. Healing in the young, therefore, is more rapid than in adults because fibroplasia begins earlier and is less retarded, not because the rate of fibroplasia is greater. Growth of the young is not hindered by the process of wound healing.
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Affiliation(s)
- E L Howes
- Department of Surgery, Yale University School of Medicine, New Haven
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Abstract
1. In plasma there exists a vasodilator substance specific for the vessels of the kidney. 2. This substance is a proteid of the albumin class and is precipitated by boiling and by alcohol. 3. It is present also in the serum. 4. It acts directly on the muscle coats of the arteries. 5. The process of clotting of the blood liberates a constrictor substance that acts on the renal vessels and also on the vessels of the limb. 6. This constrictor substance is not a proteid; it resists boiling, is soluble in alcohol, and acts directly on the muscle coat.
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Affiliation(s)
- H A Stewart
- Department of Pathology, College of Physicians and Surgeons, Columbia University, New York
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Hogan KA, Harvey SC, Conway WF, DeRosimo JF, Gross RH. Superior vena cava compression during posterior spinal fusion for idiopathic scoliosis. A case report. J Bone Joint Surg Am 2009; 91:696-700. [PMID: 19255233 DOI: 10.2106/jbjs.h.00208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kathleen A Hogan
- Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 708, Charleston, SC 29425, USA
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50
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